Please note the following discussion is for general medical education only. This discussion is not intended as individual medical advice. Please consult your dermatologist before undergoing any treatment for proper medical evaluation.
I am frequently asked “Doctor, is there anything I can do to shrink my pores?”
Yes, there are a variety of treatment options. But, first, let’s get down to basics so that you can better understand and critique the different treatment options.
Pores are essential for the healthy functioning of skin. A pore is a tiny opening or duct that travels through the superficial and deeper levels of the skin that allow for our skin to lubricate, protect, cool itself, and flush out waste products. Pores are conduits for hair follicles, oil glands, and sweat glands.
So, what makes pores visible and enlarged?
1. Genetic predisposition to enlarged pores and oily skin texture (which makes pores appear larger) is responsible in some cases.
2. Oil, dirt, and dead skin cells can mechanically block pores, leading to acne, which in turn can further enlarge and highlight the appearance of pores.
3. Acne scarring can widen and stretch out pores as can self-picking, squeezing or overly aggressive facial extractions.
4. Sun exposure and aging cause pores to appear larger due to degeneration of collagen, elastin, and other supporting skin tissues. Chronic sun exposure also tends to cause a coarse thickening of the skin which can build up particularly around the periphery of a pore further magnifying pore appearance.
So, how do I improve the appearance of the pores?
1. A smart home skin care regimen is a good first start. Home programs ideally incorporate a combination of topicals that can keep pores unclogged and skin healthy. Depending on your skin type, your dermatologist can create the most appropriate home care program for you.
a. Topical retinoids, salicyclic acid, and/or glycolic acid can keep pores open. I generally favor topical retinoids (if patients can tolerate them because they can be drying and irritating especially in the beginning) because topical retinoids can also help stimulate collagen growth in the more superficial layers of the skin and thereby improve overall pore and skin texture to some degree.
b. Topical antioxidants and daily sunscreens are important to protect skin and prevent sun damage. A well-studied and proven topical antioxidant is SkinCeuticals Vit C/E/Ferrulic acid. I recommend zinc-containing sunscreens because they are generally non-irritating and do not break down in the sun. Great brands are Elta MD, Revision, SkinCeuticals, and Neutrogena.
2. Jumpstart the body’s ability to regenerate more components of youthful skin such as collagen and elastin which can reduce pore size. This is especially necessary in the setting of sun damage, coarse skin texture, and acne scarring. Current treatment options include the following.
a. Fractional lasers (FraxelTM, Fraxel/ThuliumTM) – help for more significant textural issues, wrinkles and sun damage, significant acne scarring, lentigines (sun spots), brown discoloration
b. Photodynamic therapy – also helps for inflammatory acne, reducing oil production, sun damage, pink discolored acne scarring
c. Chemical peels (glycolic, salicyclic acid, Jessner’s, TCA peels) – also help for melasma, discoloration, acne, mild textural issues/mild sun damage
d. Intense pulse light – also helps for discoloration and mild textural issues/mild sun damage, IsolazeTM is a device that incorporates light to treat blackhead/whitehead type acne
e. TitanTM laser, ThermageTM, UltherapyTM – devices that bulk heat tissue to tighten skin – helps for loose skin but I have seen in practice that Titan laser is better for also improving superficial skin texture.
These procedures make more sense economically if there are other issues going on at the same time to be treated. For example: chemical peels for coexisting melasma, photodynamic therapy for coexisting acne, Fraxel laser for more significant sun damage and/or acne scarring, or Thulium laser for coexisting brown sun spots.
A recent study by Dr. Dover and associates found significant improvement in pore size and appearance as well as general textural improvement in most patients who were treated with a new FDA-cleared laser called the Clear + BrilliantTM. In light of this data, I would recommend this treatment if you have more mild skin issues limited to superficial textural problems such as enlarged pores and early sun damage. Like the well-known Fraxel, the Clear + Brilliant laser is also a type of fractional laser. Fractional lasers deeply treat tiny columns of skin which generates a brisk tissue regeneration response, leaving surrounding skin intact. The Clear + Brilliant can be thought of as a ‘mini-Fraxel’ because of the shared fractional technology but, unlike the Fraxel, the Clear + Brilliant delivers a more gentle treatment (not to mention more gentle on the wallet) for more mild skin complaints as mentioned previously with essentially no downtime.
In summary, a great home treatment regimen does offer benefit, but you may want to turn to other dermatologic treatments if you seek further improvement in pore appearance. If you have multiple skin issues, then your dermatologist can help to design a treatment program that most efficiently addresses all of your concerns.